Unique jaw procedure resolves toddler's obstructed airway

Tamika Winters of Brandon still wakes up at night to make sure her daughter hasn't quit breathing.

For months now, 2-year-old Taylor Brown has been sleeping peacefully. But earlier this year, the toddler's retruded lower jaw - the result of a rare neonatal infection - was causing sleep apnea so severe her breathing had become dangerously impaired.

In March, craniofacial experts at the University of Mississippi Medical Center extended her jaw using implants in a unique procedure called a jaw distraction osteogenesis that promotes bone growth. Four months later, Taylor is breathing and eating well, with a beautiful smile to boot.

Shortly after a normal, healthy birth in August 2009 in a metro-area hospital, Taylor suffered a severe infection of staphylococcus aureus, which wreaked havoc on her tiny body.

"Her doctors knew that she was kind of sick, but they didn't realize that it was an infection until later," said Winters.

After a week without success, Taylor was transferred to UMMC, where two and a half months of aggressive treatment eventually cleared up the infection. As she recovered, experts discovered that the infection had eroded bone in her hip and pelvis.

"But we didn't know that the infection had eaten her jaw," Winters said.

As Taylor grew, her breathing became more labored. In January, she had her adenoids removed, but that didn't fix the problem. That's when she was referred to Dr. Ronald Caloss, associate professor of oral and maxillofacial surgery, and plastic surgeon Dr. Michael Angel.

They ordered a CT scan and discovered her retruded lower jaw was seriously obstructing her airway.

"The bone was eroded in the condyle," said Caloss, referring to the part on each side of the mandible that hinges into the temperomandibular joint (TMJ). "This resulted in her jaw and base of tongue shifting backward into her airway.

"The condyle is a growth site for the lower jaw. So with this being affected from her infection, her jaw has not grown forward as it normally would in childhood development."

The tongue attaches to the underside of the mandible, and as the jaw grows forward, it moves the tongue forward out of the airway, Caloss said. In order to fix her breathing, Taylor needed a bigger jaw.

Jaw distraction has become an effective treatment for craniofacial abnormalities, most commonly the congenital disorder Pierre Robin syndrome. But Caloss had never heard of it being used to treat a TMJ disorder.

After planning the procedure on virtual surgery software and with models, Caloss and Angel cut through the bone on each side of Taylor's jaw behind the spot where her molar teeth are developing. Then, by attaching titanium distraction devices to the bone, they pushed the lower jaw forward gradually over the course of 10 days. In the months that follow the procedure, new bone grows in the gaps. Caloss said they usually remove the implants four to six months after surgery.

After recovering from the surgery, Taylor immediately began sleeping better and gaining weight, her mother said.

Taylor's mother and father, Darryll Brown, are thrilled at how much she's improved since March, but say they can't help wishing she had arrived at UMMC sooner.